HomeAnswersRheumatologyrheumatoid arthritisWill long time steroid use for RA prevent me from having children?

Will long time steroid use for RA prevent me from having children?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At March 20, 2018
Reviewed AtJuly 13, 2023

Patient's Query

Hello doctor,

I am a 28-year-old male. I have been diagnosed with RA. And another rheumatologist told me I do not have enough symptoms for RA. However, I have been using Methylprednisolone 4 mg for almost four years every day. And this helps me completely get rid of any problems. If I do not take it for a day all my joints start to swell and it is unbearable. The second rheumatologist prescribed Methotrexate to me and now I am taking this for already four months together with Methylprednisolone. But, I still cannot get rid of the Methylprednisolone. How dangerous is it to take this drug for already so long? Will it prevent me from being able to have children? What is my best option? I am open to traveling to any hospital in the world. Symptoms started four years ago.

Hello,

Welcome to icliniq.com.

Well, it is a tough spot you are in. It will be difficult for a new rheumatologist to diagnose if you are already on steroids and the symptoms get masked. But I will try to simplify it for you here. Could you let me know the results of rheumatoid factor, anti-CCP antibody, and ANA? If they are negative, it will reduce the probability of rheumatoid arthritis. Steroids on a long-term basis are always harmful. It can cause cataracts, osteoporosis, and diabetes mellitus. It is like a drug that cannot be withdrawn so easily. So, to figure out if it is rheumatoid or not the first thing is serology (blood test advised). The second is to get an ultrasound of the joints done. It will help us detect if there is anything underlying. Either way, steroids are not an option for you. You will have to put in a lot of effort to go off it. Your doctor may have to give you a steroid-sparing agent for a short course to help you come off it. Steroids as such do not cause difficulty in pregnancy, but they do cross the placenta if taken on a higher dose and may affect the baby. So, we got to get you off it and streamline your treatment. Firstly, if it is rheumatoid or not, and secondly what medications do you need?

Thank you.

Patient's Query

Hello doctor,

This is what I have been given four months ago. I was already on the drugs for three years. And went to a rheumatologist for the first time, after three years. This came out in the analysis: CRP 1.27, ANA 0.54, RF 28,4, and ANTI RNP <1,0. So, do I have to get off the drugs I am taking? How do I start? What if I just stop taking it and my joints start to swell and it becomes unbearable? How long does it take to get completely off it? I was thinking of reducing the intake every day by five or 10 per week. Is that a good way to go? Also, I forgot to mention that since all of this started, I bruise very easily. Any bump on my leg and it gets heavily bruised. Does that have anything to do with it?

Thank you.

Hello,

Welcome back to icliniq.com.

Long-term steroids are not an option at your age. We only use it for lupus or vasculitis and that is also at a minimum dose (that would be 2 mg once in three days sorts). So, we need to go off it. For reducing it, I would suggest taking 4 mg one day and 2 mg the other day for three weeks and then reducing it to 2 mg daily for the next three weeks and then 2 mg on alternate days. Consult your specialist doctor, discuss with him or her, and start taking the medicines with their consent. When you take steroids from outside, your body stops producing the steroid hormone, which is our main stress hormone and we need to stimulate the body to produce it again. So, that usually takes around three weeks (after we make it on alternate days that is) to start producing again. So, that period is tough with a lot of pain and you will have to manage it with safer painkillers like Tylenol or Paracetamol. The bruising you are mentioning is due to long-term steroid use. It weakens the normal skin structure and they start getting bruised for no reason. So, it is one of the side effects. As per your blood test, the disease does not look very active. But if you fear the joints will swell up on tapering steroids, I would suggest letting that be. We as a rheumatologist are more comfortable starting you on proper treatment (Methotrexate or Sulphasalazine) when we see these swollen joints than when the swelling is hidden due to a steroid. The moment they swell up, keep an early appointment with a rheumatologist and let them start you on the treatment they feel will benefit you.

I hope the information was useful.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

I already mentioned that i am already taking also Methotrexate. Should I continue taking this while I am reducing Medrol?

Thank you.

Hello,

Welcome back to icliniq.com.

Well, if the joints are swelling up and pain is coming back on tapering Medrol, Then it s time we step up your medicines.

1. For now, dont reduce medrol further till your rheumatologist sees you and is convinced that joint inflammation is back. But try to schedule an appointment early before the disease jumps up more.

2. There is a possibility Methotrexate 20 mg alone is not working for you. You were having a good control on steroids but since that was giving you side effects in the long run, we need to add another substitute. 60 % people are well controlled on single drug.

But if your swelling is coming back we need to add the next line like Sulphasalazine or hydroxychloroquine (that depends on what the outcome of your joint examination and lab reports is). Well, for the last part it is a bit tough for me to guide you to a rheumatologist around your place. You can always ask your rheumatologist that you seek another opinion and they would be more than happy to help you. Also, please get these blood tests repeated:

1. CRP

2. ESR

3. Liver function tests

4. CBC

Kindly update me with the results.

Thank you.

Patient's Query

Hello doctor,

A few days back, I had swelling again. However, I traveled because of climate change (colder climate). No idea if that is anything to do with it. But since then, I have had no pain. And I am currently taking Medrol 2 mg every other day. I am currently on 15 mg of Methotrexate once a week. I am very happy that I am on less Medrol than I was. I was home last week and did some tests at home because my legs are incredibly blue. But they do not know what it is. I was hoping that if I went off Medrol, my legs would return to normal.

1. Do you have any advice on what I can do against the incredibly blue legs?

2. Should I reduce the tablet dose?

3. What if I go completely off Medrol?

4. How long does the blue bruising take to go away after stopping Medrol completely?

I basically started to bruise easily since I started Medrol. However, the bruising is much more than it was ten months ago. When I started the Methotrexate ten months ago. The bruising became twice as much.

Please see some test results from last week attached.

Thank you.

Hello,

Welcome back to icliniq.com.

Well, it s good to know you are doing well even with a lower dose of Medrol.

1. Bruising as such is usually caused by Medrol only as it weakens the skin tissue. But if you could send a picture, it would be helpful. Just want to be sure there are no varicose veins. Methotrexate does not cause bruising as a side effect.

2. We can reduce the dose since you are doing well on Methotrexate 15. If any swelling comes up, we can also increase methotrexate to 20 mg.

3. Recommended dose: 2 mg Medrol twice a week, and then gradually go off after 4 to 6 weeks.

4. For bruising, start on a Vitamin C supplement, which helps strengthen the capillaries. But do check for varicose veins, as treatment will differ.

Thank you.

Patient's Query

Hello doctor,

From now on, I will start with Medrol twice a week. Please see a picture of my bruised legs attached.

Thank you so much.

Hello,

Welcome back to icliniq.com.

Well, I think it s time we taper your Medrol. If you experience joint swelling, show it to your doctor, so we are sure it is arthritis only, which is coming back, and we can step up the dose of Methotrexate.

I have reviewed the pictures (the attachment was removed to protect the patient's identity). The bruising is immense. Also, a lot of varicose veins can be seen. Did you ever do a venous doppler for your lower limbs? As such, we do not expect it at your age. Also, we need to see your other tests for clots like PT, APTT, and INR to be sure it is not something else we are missing. Vitamin C is known to help this capillary breakdown to prevent bruises. So it is worth a try. Do let me know these couple of queries.

Thank you.

Patient's Query

Hello doctor,

No, I never did that venous doppler. I started using less Medrol. I am now using one time, 2 mg a week. And I thank you for helping me with that. Should I try to go entirely off it soon? I took the vitamins, and I did feel a little change. My legs are less sensitive, and I bruise less easily. But the old bruises do not go away. Please review the attached images.

Thank you.

Hello,

Welcome back to icliniq.com.

Well, it s great to know you are almost off steroids. Well, 2 mg a dose is as good as not on it as our body produces more daily steroids. I guess you can stop it over the next couple of weeks. I have reviewed the images (attachment removed to protect the patient's identity), and the pigmentation is quite some. I would suggest getting a venous doppler first to be sure the veins are not causing such pigments. And then, you will have to seek an opinion from a dermatologist. I am unsure how much they can help remove it but maybe lighten it. But we need to see why it is happening. So, I would suggest going off Medrol and getting a venous doppler. If the doppler is normal, you seek an appointment with a dermatologist.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Naval Mendiratta
Dr. Naval Mendiratta

Rheumatology

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